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PubMed2002

Primary anastomosis and diverting colostomy in diffuse diverticular peritonitis.

BACKGROUND: Despite the well documented morbidity associated with its reversal, Hartmann's procedure remains the favoured option in patients with complicated diverticular disease in the presence of diffuse peritonitis. A prospective study was conducted to determine whether primary anastomosis with diverting colostomy constitutes a valid alternative to the Hartmann procedure. METHODS: Between 1994 and 1998, all patients with diffuse peritonitis due to perforated diverticulitis of sigmoid origin underwent resection and primary anastomosis with diverting colostomy. Restoration of colonic continuity was programmed six weeks later, after verification of the anastomose by gastrografin enema. The group included 5 men and 15 women with a mean age of 72 years (32-97 years). The ASA classification of the patients was as follows: ASA II (n = 2), ASA III (n = 12), ASA IV (n = 3), ASA V (n = 3). The mean delay between onset of symptoms and surgery was 74 hours (8-215 hours). RESULTS: Operative mortality and morbidity was 15% (n = 3) and 50% respectively. No patients showed signs of suture disruption and this was confirmed by routine radiological controls of the anastomoses. Mean length of hospitalization was 20 +/- 10 days (SD; median: 18 days). Closure of the colostomy using a small peristomal incision was performed in all surviving patients after a mean delay of 45 +/- 9 days (range 28-67 days). Mean length of hospitalization for colostomy closure was 7 +/- 3 days (range 3-18 days) without mortality. CONCLUSIONS: Applied systematically to all patients with diffuse peritonitis due to perforated diverticular disease, primary anastomosis was found to be as safe as the Hartmann procedure but appears to be superior in terms of total length of hospital stay, interval to stoma closure and rates of stoma closure. Primary anastomosis with diverting colostomy could constitute a valid alternative to the Hartmann procedure in selected patients with complicated diverticular disease, even in the presence of diffuse peritonitis.

Aged↗
PubMed1993

Same admission colostomy closure (SACC). A new approach to rectal wounds: a prospective study.

OBJECTIVE: The purposes of this project were to study the healing of protected rectal wounds (RWs) using contrast enemas (CEs) and to establish the safety of same admission colostomy closure (SACC) in terms of colostomy closure (CC) and rectal wound-related outcomes, for selected patients with radiologically healed RWs. SUMMARY BACKGROUND DATA: Traditional treatment of RWs has included a diverting colostomy that is closed 2 or more months later during a readmission. METHODS: All patients admitted with a rectal injury were entered into this prospective study, treated with a diverting colostomy and presacral drainage, and managed according to a postoperative protocol that included a CE per anus to detect healing of the RW. Patients with no leaking on their first CE, no infection, and anal continence underwent SACC. RESULTS: From 1990 to 1993, 30 consecutive patients had rectal injuries, 90% of which resulted from gunshot wounds. The first CE was performed in 29 patients 5 to 10 days after injury. In this group, 21 patients did not and 8 did have leakage from their RWs. The proportions of RWs radiologically healed at 7 and 10 days after injury were 55.2% and 75%, respectively. Sixteen patients with a normal CE underwent SACC 9 to 19 days after injury (mean, 12.4 days). There were two fecal fistulas (2 of 7; 28.6%) after simple suture closure, none (0 of 9) after resection of the stoma with end-to-end anastomosis, and no RW-related complications after SACC. The mean hospitalization time was 17.4 days. CONCLUSIONS: The following conclusions were drawn: (1) CE confirmed healing of RWs in 75% of patients by 10 days after injury; (2) 60% of patients with RWs were candidates for SACC, and 53% were discharged with their colostomies closed; (3) SACC was performed without complications in 87.5% of patients with radiologically healed RWs; and (4) there were no RW-related complications after SACC.

Adolescent↗
PubMed1994

Laparoscopic ileostomy and colostomy.

OBJECTIVE: The technical features of laparoscopic ileostomy and colostomy are described. SUMMARY BACKGROUND DATA: A diverting ileostomy or colostomy can be performed with minimal trauma by laparoscopic techniques. This is distinct from the complex laparoscopic and laparoscopic-assisted resections of small and large bowel. To date the technical features of creating a diverting ileostomy or colostomy have not been emphasized sufficiently. METHODS: Standard laparoscopic techniques are used to create a pneumoperitoneum. After mobilization of the ileum or colon, a stoma is made on the abdominal wall. A trocar is introduced at the site where the stoma is located, thus reducing the technical problems associated with creating and maturing a stoma while the abdomen is insufflated. RESULTS: This approach obviates the need for a laparotomy while creating an ileostomy or colostomy. The technical features of creating a double-barrel ostomy, an end-ostomy with a stapled distal limb, and a loop ostomy are described. The postoperative recovery is prompt with a rapid return of intestinal function and early discharge from the hospital. CONCLUSIONS: Laparoscopic ileostomy and colostomy are straightforward procedures that reduce postoperative discomfort and ileus, and reduce the length of hospital stay.

Adult↗
PubMed2001

A new approach to extraperitoneal rectal injuries: laparoscopy and diverting loop sigmoid colostomy.

BACKGROUND: Current management of extraperitoneal rectal injuries involves a laparotomy and diversion of the fecal stream. In this study, we review our experience with laparoscopy and diverting loop sigmoid colostomy without laparotomy in the management of these injuries. METHODS: All patients admitted to the trauma unit at Groote Schuur Hospital between January 1995 and May 2000 with a rectal injury were evaluated. The presence of a rectal injury was confirmed by rectal examination and proctosigmoidoscopy. Intraperitoneal injuries were excluded by laparoscopy. Only patients who did not have intraperitoneal injuries were included in the study. The patients were then managed with a diverting loop sigmoid colostomy created through an abdominal wall trephine without laparotomy. RESULTS: Ten patients were included in the study. In eight patients, laparoscopy excluded intraperitoneal injuries. All 10 patients had a diverting loop sigmoid colostomy fashioned. There were no complications related to either the rectal injury or colostomy. Nine stomas have since been closed. CONCLUSION: In patients with isolated extraperitoneal rectal injuries, laparoscopic exclusion of intraperitoneal injuries, followed by a diverting loop sigmoid colostomy, is a feasible option.

Adolescent↗
PubMedDate not supplied

Self-image changes with time in the cancer patient with a colostomy after operation.

Persons undergoing colostomy surgery face body mutilation and some loss of body function, which in turn causes their concept of self to change. Although nurses use physical and behavioral indicators as bases for assessment, planning, and evaluation of nursing intervention, only minimal empiric data is available on the physical and behavioral indicators of self-concept changes (e.g., lack of participation in self-care, depression, anxiety, fear of social rejection) among these patients. This study is a beginning in the description of the self-concept changes with time of the patient with a colostomy. The purpose of this study was twofold: (1) to begin the description of the postoperative behavioral indicators of cancer patients with colostomies according to Erikson's stages of trust and autonomy at 4 and 12 weeks after operation; and (2) to measure several indexes of psychosocial discomfort anticipated by patients before colostomy operations and them measurements with measurements of psychosocial discomfort at 4 and 12 weeks after operation. The study design incorporated three serial assessments. Each consenting subject was interviewed once before the operation and twice after (at 4 and 12 weeks). The study sample consisted of 12 subjects who had colostomy operations for cancer. Ages ranged from 41 to 74 years, with a mean age of 59.4 years. Results show an increase in trust, from a mean of 203.6 at 4 weeks to a mean of 221.7 at 12 weeks. Autonomy scores decreased, from 146.2 at 4 weeks to 143.9 at 12 weeks. Psychosocial discomfort decreased from 25.7 before to 22.1 4 weeks after and 8.0 12 weeks for operation.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Health-related quality of life among persons living in Japan with a permanent colostomy.

OBJECTIVE: To compare the health-related quality of life (HRQOL) of persons with a permanent colostomy to that of the general Japanese population and explore the factors influencing HRQOL. DESIGN: A cross-sectional survey. SETTING AND SUBJECTS: A total of 255 persons with an ostomy who attended a meeting of the Japan Ostomy Association in the Kanto region of Japan. INSTRUMENTS: The HRQOL was assessed using Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Japanese version 1.2. Factors potentially influencing the HRQOL were age, sex, marital status, employment status, number of people in the household, time since colostomy, and diagnosis. METHODS: Questionnaires were distributed to the subjects and SF-36 scores were determined and compared with the corresponding national-norm data by Wilcoxon signed rank sum test. A logistic regression analysis was used to explore the influencing factors. RESULTS: The questionnaire response rate was 66.7%. Subjects with a urostomy or an ileostomy and those with missing data were excluded. Data from 102 subjects with a permanent colostomy were analyzed. The subjects' scores were significantly lower than the national-norm scores in the role-physical and social functioning scales. Being employed was associated with significantly lower scores or associated with a tendency toward lower scores. CONCLUSIONS: Scores in two scales in these subjects were lower than those of national-norm scores. Being employed had a negative impact on the HRQOL of subjects with a permanent colostomy. The results of this study provide reference data for future research and underscore the importance of support for persons with a colostomy.

Activities of Daily Living↗
PubMed1986

The effect of stapler diameter and proximal colostomy on narrowing at experimental circular stapled large bowel anastomoses.

The effect of stapler diameter and proximal colostomy on large bowel anastomotic narrowing was studied in 23 ewes, to test the hypotheses that stapler diameter is inversely proportional to narrowing and that a colostomy increases narrowing. Large bowel anastomoses were performed with ILS Proximate circular staplers of 25, 29 and 33 mm diameter (six in each group), and assessed at 12 weeks for anastomotic narrowing, hydroxyproline content and histology. In five animals a proximal loop colostomy was added after anastomosis with the 29 mm stapler and similarly assessed at 6 weeks. Neither radiological nor clinical anastomotic leaks occurred and there were no deaths. Comparison of narrowing indices showed no statistically significant difference between the three stapler diameters. Colostomy significantly increased narrowing. Hydroxyproline content was greater at all anastomoses compared with controls. Anastomoses with the 25 mm staplers had a significantly reduced hydroxyproline content compared to the 29 and 33 mm staplers, which may be explained by anastomotic dilatation. The tendency for stapled anastomoses to develop narrowing should not necessarily influence the surgeon's choice of stapler diameter when performing large bowel anastomoses. Moreover, dilatation by faeces may be a factor in reducing staple anastomotic narrowing and, when safe, a proximal colostomy is best avoided.

Animals↗
PubMed2006

Double-barrelled wet colostomy with simultaneous urinary and faecal diversion: results in 9 patients and review of the literature.

OBJECTIVE: Double-barrelled wet colostomy is a urinary diversion technique indicated when a concurrent faecal diversion is needed. It is a simple procedure, technically easy to accomplish and well received by patients. The purpose of this study is to report the results of double-barrelled wet colostomy, with emphasis on operating technique, morbidity, functional results and a review of the literature on the subject. METHODS: The medical records of 9 consecutive patients, between January 2001 and May 2005, who underwent surgical extended resections with double-barrelled wet colostomy for a malignant central pelvic mass, were reviewed retrospectively. The patients were asked to respond to a questionnaire assessing quality of life. The questionnaire used was the QLQ-C30 version 3, proposed by the European Organization for Research and Treatment of Cancer (EORTC). RESULTS: This study presents results obtained from 9 patients, emphasizing morbidity and quality of life. One patient presented with pyelonephritis. We did not identify complications such as hydroelectrolytic disturbances, peristomal dermatitis or hydronephrosis. The patients who submitted to the procedure exhibited high levels of quality of life and found caring for the stomas straight forward. CONCLUSIONS: We conclude that double-barrelled wet colostomy is an excellent choice for patients who require concurrent urinary and faecal diversion, one that does not present technical difficulties and does not require a prolonged operating time. It avoids the complications frequently present in standard wet colostomy and does not rule out making a continent urinary reservoir later, in patients that meet healing criteria.

Adult↗
PubMed2002

Sigmoidoscopy-assisted colostomy--an adapted trephine stoma formation.

BACKGROUND/AIM: The purpose of this article was to report an adapted colostomy procedure that can be used on patients with multiple morbidities requiring fecal diversion. METHODS: An adapted colostomy was performed on a patient needing fecal diversion who had multiple surgical and medical complications. RESULTS: Thirteen weeks after colostomy placement, the patient's colostomy functioned well and was viable throughout his course without related complications. CONCLUSION: The method of sigmoidoscopy-assisted colostomy described here can be beneficial to the complicated patient needing fecal diversion but unable to tolerate a laparotomy or laparoscopy.

Aged↗
PubMedDate not supplied

[Study of artificial valves on left colon after rectal partial abdominoperineal resection with perineal colostomy, in dogs].

BACKGROUND: Throughout time, perineal colostomy in abdominoperineal resection, as a way to avoid abdominal colostomy, was studied. Perineal colostomy associated with a slowing down mechanism for stool transit has been studied for many years with satisfactory results. AIM: The investigation of a colic valvoplasty in dogs which have undergone an abdominoperineal resection plus perineal colostomy, and the discussion of the results achieved in clinic and histopathologic analysis are the objective of this study. MATERIAL AND METHODS: The experimental model of this research studied the colon of dogs. Sixty five animals were operated and divided in five groups: 10 animals in the pilot group, 15 animals in control group and 40 animals in 3 other groups of observation with 10, 20 and 30 days of postoperative care. The dogs underwent a rectal partial abdominoperineal resection with perineal colostomy associated to a circumferential extramucosal seromiotomy of the left colon (except in the control group). RESULTS: Through postoperative and post-mortem observation it was possible to verify solid stool before the valves showing the efficiency of the mechanism in slowing it down. The histological analysis of the valves showed connective growth with fibrosis in the whole incised serous and muscular layers, separating them. A fibrous ring diminished the colon lumen in response to the artificial valve created by the scar that appeared in the inverted suture of the serous and muscular layers. The inflammatory fibrous repair process occurred in all valves, associated to foreign body type reactions and to partial stricture of the colon lumen. CONCLUSION: The circumferential seromiotomy produces a fibrous ring that provides stool retention on the descending colon.

Anal Canal↗
PubMed1999

Colostomy closure: impact of preoperative risk factors on morbidity.

The objective of this study was to stratify patients for colostomy closure into risk categories according to preoperative variables. This was a retrospective case series. Median follow-up was 82 months. A tertiary care academic medical center was the setting for this study. A study sample of 155 consecutive patients who underwent colostomy closure at a single institution between 1985 and 1995 were included in this study. The following preoperative variables were analyzed: indication for colostomy fashioning; age; gender; American Society of Anesthesiology (ASA) class; presence of cardiac, renal, or pulmonary dysfunctions; presence of diabetes mellitus; and immunosuppression. The occurrence of adverse outcome, as evidenced by postoperative morbidity and mortality, was used as the main outcome measure. Complications occurred in 49 patients (31.6%), including a 1.3 per cent mortality. There was a trend of increasing morbidity with increasing ASA class. The single factor that showed a statistically significant increase in morbidity was the presence of diabetes (P = 0.036). Predicted probabilities of complications for patients with ASA III with renal disease was 31 per cent, increased to 47.9 per cent if cardiac disease was also present and to 77 per cent with the addition of diabetes. The presence of diabetes carries an independent risk factor for adverse outcome in colostomy closure. This study provides information about stratification of postoperative risk based on commonly available preoperative variables. In the majority of cases, colostomy closure seems to carry a very acceptable complication rate. In selected patients with multiple preoperative risk factors, the morbidity becomes significantly higher.

Adult↗
PubMedDate not supplied

[Perineal colostomy: the surgical challence of continence. Critical review of the literature].

The aim of the study was to evaluate perineal colostomy as a treatment choice to avoid abdominal colostomy and its physical and psychological consequences. It has been viewed with some scepticism because of its variable outcome. The main studies by investigators involved in this surgical challenge available through Pub Med were reviewed and analysed. The review of the literature shows that a more complex procedure (simple perineal colostomy, smooth muscle sphincter, unstimulated graciloplasty, electrostimulated graciloplasty) does not always guarantee successful continence in the sense of the ability to contain and expel faecal content at will. Perineal colostomy with various technical variations is an alternative to abdominal colostomy but is unable to restore continence in cases of serious impairment of the pelvic dynamics.

Colostomy↗
PubMedDate not supplied

Actinic rectitis--the role of colostomy.

From 4132 patients treated with radiation therapy due to gynecological malignancy from 1974 to 1988, 527 (12.75%) developed some grade of actinic rectitis with clinical manifestation. The authors analyzed the efficacy of colostomy in the management of 10 women with actinic rectitis grades I and II (Sherman classification) submitted to clinical treatment without response. Pelvic radiation therapy, clinical findings, proctoscopy and rectal biopsy were the basis for the diagnosis and staging of the actinic rectitis. All colostomies were made in the transverse colon and the median follow up from colostomy to last review was 53 months. Eight patients had complete remission of clinical findings after colostomy, but one had recurrence of symptoms 2 years later. One patient had incomplete remission but with clinical improvement and one patient had tumor recurrence. From 8 patients with complete clinical remission, 2 had the colostomies closed, but in 1 was restored 3 months later due to rectum-vaginal fistula.

Adult↗
PubMedDate not supplied

[The complications of colostomies].

The evaluation of the frequency of complications that arise after colostomies performed for colorectal and genital neoplasm, and also the treatment possibilities for these complications. In Colţea Hospital, Surgical Department during 1984-2002 there have been admitted and surgically treated 891 patients with colorectal cancers, among which, 484 had rectosigmoidal neoplasm. We have treated 25 patients with complicated genital neoplasm (19 rectovaginal and recto-bladder-vaginal fistulas following cervical cancers, 5 pelvic tumoral blocks following ovarian cancers and a vulvar cancer with local invasion). For all these patients we performed: 25 Hartmann resections, 75 Reybard resections, 73 Dixon resections and 147 rectal amputations, with 294 colostomies (30 iliac anus in continuity-Audrey, 18 on a stick, 232 terminal and 14 cecostomies for protection or decompression). There were 48 complications following the colostomies: 10 cases of stenosis, 14 prolapses, 7 intestinal loop necroses and 17 parastomal hernias, all of them surgically managed. Terminal colostomies and colostomies for protection are still frequently used in surgical departments, having strict indications. Because they are frequently performed as emergencies, at patients with poor biological status they are often enough followed by complications, most of them with little gravity. The complications can be avoided by a proper therapeutic choice and in most cases can be managed with a surgical intervention.

Adult↗
PubMedDate not supplied

[The elective use of protective colostomy in rectal resection surgery].

To clarify the indications and clinical value of "protective colostomy" in cases of low colorectal anastomoses, some recent series are analyzed and compared to the experience of the authors, which includes 65 low anterior resections of the rectum for cancer, with colorectal anastomosis at less than 10 cm from the anus. "Protective colostomy" seems not to prevent the onset of anastomotic fistulae, but appears effective in reducing its clinical effects. "Protective colostomy" seems convenient when there is an increased risk of fistulization, as indicated by a series of factors defined by the authors. In doubtful cases "protective colostomy" may be performed but not opened. So the patient will be given the maximum safety, and not submitted to the uneasiness of an open colostomy unless needed.

Aged↗
PubMed1990

[Determining the time of closure of double-trunk and marginal colostomies].

An analysis of incidence of postoperative complications of restorative operations in 215 patients with double-barreled and marginal colostomies++ has shown that terms of performing the operations do not influence the character of the postoperative period. A cytological investigation has shown that inflammatory alterations make their appearance at early terms (up to 2 months) of the colostomies++ existence. Closure of the colostomies++ should be performed after elimination of causes of their appearance, when there are no pronounced inflammatory alterations of the intestinal wall of the colostomy and when the patient's condition is good. At early terms resection of the intestinal wall with the colostomy and the end-to-end anastomosis should be performed.

Colon↗
PubMed1990

[Complications of colostomy in childhood].

The complications of 86 colostomies in 70 patients are reported. The most frequent indications were necrotizing enterocolitis and Hirschsprung's disease. More than half of the children were less than one week of age at the time of surgery. Most frequently transverse colostomies were performed. Most colostomies existed for 1-3 months. In 58% of the children no complications occurred, which could be attributed to the colostomy. Thus, the complication rate of the colostomies was 42%. The most common complications were strictures, adhesions with bowel obstruction, enterocutaneous fistulae, occasionally leading to abscess formation, and candida mycosis.

Abscess↗
PubMedDate not supplied

[Definitive colostomy and quality of life].

The authors present their experience with permanent colostomy after abdominoperineal resection of the rectum. In order to avoid colostomy-related complications, pre- and postsurgical care are of paramount importance as well as a proper surgical technique. Extraperitoneal colostomy prevents the frequency described early and late complications. Learning colostomy irrigation helps the patient to overcome any physical or psychological problems related to colostomy.

Colostomy↗